Open AccessIncidence, risk factors, and outcomes of central venous catheter‐related thromboembolism in breast cancer patients: the CAVECCAS study
Author(s) -
Debourdeau Philippe,
Espié Marc,
Chevret Sylvie,
Gligorov Joseph,
Elias Antoine,
Dupré Pierre François,
Desseaux Kristell,
Kalidi Issa,
Villiers Stephane,
Giachetti Sylvie,
Frere Corinne,
Farge Dominique
Publication year - 2017
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1201
Subject(s) - medicine , asymptomatic , breast cancer , cumulative incidence , incidence (geometry) , pulmonary embolism , prospective cohort study , surgery , cancer , cohort , optics , physics
Abstract Previous epidemiologic studies investigating central venous catheter ( CVC )‐related venous thromboembolism ( CRT ) were conducted in heterogenous cancer populations and data in breast cancer ( BC ) remain limited. To investigate the Doppler ultrasound ( DUS )‐ CRT incidence, risk factors and outcomes in BC , we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double‐blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow‐up. Symptomatic DUS ‐ CRT were treated by anticoagulants. D‐Dimers, thrombin generation, and platelet‐derived microparticles were measured before and 2 days after CVC placement. In DUS ‐ CRT patients, a nested case–control study analyzed the role of thrombophilia. Among 524 patients, the DUS ‐ CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient‐months). Ten/14 symptomatic DUS ‐ CRT were detected on double‐blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS ‐ CRT . Age >50 years ( OR , 1.80; 95% CI , 1.01–3.22), BMI >30 kg/m² ( OR , 2.64; 95% CI , 1.46–4.76) and comorbidities ( OR , 2.05; 95% CI , 1.18–3.56) were associated with DUS ‐ CRT . No biomarkers was found to predict DUS ‐ CRT . In multivariate analysis, BMI >30 kg/m² ( OR , 2.66; 95% CI , 1.46–4.84) and lobular carcinoma histology ( OR , 2.56; 95% CI , 1.32–4.96) remained the only significant DUS ‐ CRT risk factors. Thrombophilia did not account for DUS ‐ CRT . Only clinical parameters identified high risk DUS ‐ CRT patients who may be considered for thromboprophylaxis.